RALEIGH, N.C. (WECT) – North Carolina Insurance Commissioner Mike Causey has fined the nation’s largest health insurer $3.4 million following a four-year investigation into UnitedHealthcare’s practices, the North Carolina Department of Insurance announced Friday.
The NCDOI reports the investigation revealed UnitedHealthcare did not follow its own procedures to protect members from balance billing, also known as “surprise billing.”
Balance billing occurs when an out-of-network provider charges a patient with the amount the insurance company doesn’t pay, and attempts to collect the excess cost from the patient.
“Patients receiving emergency room services certainly don’t have the time or capacity to go through a checklist and make sure all providers attending them are in-network,” Commissioner Causey said in Friday’s press release. “UnitedHealthcare’s practices potentially put unnecessary financial burdens on many North Carolinians. I am happy to see that UnitedHealthcare has agreed to take corrective action.”
According to the NCDOI, UnitedHealthcare has agreed to provide the Department of Insurance with a corrective action plan to address violations uncovered in the investigation and submit to future compliance examinations. However, the health insurance company did not admit to the findings contained in the report, and denied violating any statues, rules or regulations.
In a statement to WECT, a spokesperson with UnitedHealthcare said Monday, “We are committed to protecting our members from out-of-network care providers who bill excessive fees, particularly in acute or urgent settings. We continue to comply with all state and federal laws, including the federal “No Surprises Act,” which protects members from balance billing.”
The investigation began in the NCDOI’s Market Regulation Division after the department’s Consumer Services Division saw a trend of complaints from UnitedHealthcare’s members.
A review of the complaints found that members were being subjected to cost sharing more than deductible, copayment and coinsurance liabilities, according to the NCDOI.
The services were mainly provided by out-of-network emergency room departments, laboratory services, and anesthesiologists.
The report states, “The companies’ failure to have in-network anesthesiology and laboratory providers available at in-network facilities should not affect the member’s benefit level or cost-sharing responsibilities for covered services.”
It is also against North Carolina law. According to North Carolina General Statute 58-3-200(d), “No insurer shall penalize an insured or subject an insured to the out-of-network benefit levels… unless contracting health care providers able to meet health needs of the insured are reasonably available to the insured without unreasonable delay.”
“This is a big deal,” NCDOT Communication Director Jason Tyson said. “We never want a North Carolina health insurance company to make things harder outside the scope of the law for a patient.”
The $3.4 million fine will be distributed to public schools, as required in the North Carolina Constitution.
The fine comes months after former UnitedHealthcare CEO Brian Thompson was gunned down on a busy Manhattan street, prompting an outcry over the nation’s health care system. In December, 26-year-old Luigi Mangione was arrested and charged in the killing.
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